Join me for the next 10 minutes in this safe, sacred space I am creating for us to start a conversation. About sexual health. If you would like to. I hope you will. Because sexual health is deeply important to our whole selves as women.

Go ahead and grab something to write on and a pen for a short exercise.

Sexual health is not just about “having sex.” It’s about your body. Your sensuality. Your confidence. Pleasure. It’s about relationship. Safety. Your vagina, and uterus and breasts. [YES, I said it: V-A-G-I-N-A.] It’s also about creativity and the divine feminine. It’s about dancing your dance as a woman, as ecstatically as you can and want to.

As a midwife and physician specializing in women’s health, talking about sexual health is a big part of what I do to help women feel and get healthy. I love helping women find, honor, rekindle their sexual mojo. Their empowered embodiment of creative, fertile self – at any age. We all need a girlfriend gynecologist we can talk to! TADA! Genie in a bottle, at your service!

Here’s the thing. When it comes to sexual health so many of us are in the dark because:

Doctors are too uncomfortable talking about sexual matters with their patients. One recent survey estimated that only 14% of Americans aged 40 to 80 years reported that a physician had inquired about sexual concerns within the past 3 years! Words like discharge, orgasm, and pleasure just freak people out. So they avoid them. Then those questions go unanswered.

Women are usually too uncomfortable talking about their sexual health with their docs – even their gynecologist! So the conversation doesn’t happen. Questions go unasked, symptoms go unchecked. And women worry in silence about whether they are “normal.”

Most of us have misconceptions and misinformation about what’s normal about our bodies and about sex. These often start when we’re young due to inaccurate or misunderstood information from our moms, friends, and teachers. Then we grow up exposed to unrealistic ideas about sex and our bodies through movies, TV, and magazines. Some women carry inaccurate ideas with us throughout their lives.

Most women have questions, concerns, and maybe something we’re curious about, but don’t know how to ask or where to find trustworthy answers.

TRUE STORY: In 6th grade my friend Carol took a mandatory school-based sex ed class where she learned that you stop getting your period when you are pregnant. Though she was a virgin, when all the girls around her age started getting their periods and she didn’t, she was terrified that she was pregnant. She carried this worry until she started menstruating 2 years later!

TRUE STORY: One of my teenaged daughters once asked me if giving a guy oral sex prevented cavities in the girl. Seriously! Now which gender made THAT up? But she really didn’t know. Thankfully she could ask and I could tell her it CAUSED cavities! (Kidding, I didn’t tell her that. But I did tell her guys made that up and it doesn’t protect against tooth decay!) Did you know the most teenagers think that oral sex is not having sex and has no risks?

TRUE STORY: I once taught a weekend intensive on women’s health to 30 women aged 30-60 years old. None of them knew what their vulva is. (Do you know?)

TRUE STORY: A pregnant woman once called me with vaginal bleeding. She was about 5 months along and inserted a jelly jar into her vagina to make sure she’d be able to stretch open at the time of birth. She didn’t know that hormones kick in at the end of pregnancy to facilitate this, but they are not kicked in until then.

TRUE STORY: A lovely woman in her mid-50s contacted me by phone from another state. She had been so afraid to get a pap smear because of a prior bad experience at a gynecology appointment, that she hadn’t had one in 20 years. By the time she contacted me she’d had serious vaginal discharge for over a year. She was scared and embarrassed. I convinced her to see a woman nurse practitioner in her city for a pap, during which she bled heavily because her cervix was so damaged from advanced cervical cancer that had gone unnecessarily undetected.

I want you to be well informed, healthy, happy, and empowered. I want you to feel free to be honest with your Sexual Self about she’s doing. And I want you to know that you have the right and deserve to be treated kindly and gently by your doctor and by any sexual partners.

And I want to hear from you and help you embrace your most joyous, vital, creative, healthy self.

Let’s begin with a Safe Space Body Awareness meditation:

Close your eyes.

Imagine that there is a soft, pink, warm bubble around us, the size of a comfortable room. In this space you are warm and protected. Everything that is said here is confidential and sacred.

Now, take a few deeps breaths. Make your mind and your belly soft. Breathe deeply and slowly, inhaling to the count of 4, imagining your breath bringing a warm, glowing, pink light all the way down into your sacred woman parts. Imagine this soft light bathing your pelvis, all the way down to your pelvic floor. Feel warmth spreading through your lower abdomen. Notice any areas where you feel tight, tense, blocked and use this light to massage them free. Then exhale to the count of 6, letting go of all the tension in your body. Quiet your mind and focus only on the rhythm of your breath and the feeling of your breath moving deeply through your body. Repeat this 8 times. There. Now open your eyes.

Go ahead and grab your pen and notebook. Take another deep breath.

Quickly jot down 2 questions that your Inner Goddess has been nagging at you about your sexual health that you need to address…And begin to reflect on how you’re going to do that!

Questions and comments are most welcome. Drop ’em below. They will be screened before they are posted to keep this site comfortable for readers. Please respect this site as a sacred space for women and please don’t take it personally if your question doesn’t appear. I will not be answering personal medical questions.

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31 Comment

lydia

Excellent post! I am VERY excited for this series. This is definitely a topic more people need to get comfortable with and even further educated on! Kudos to you -I'll be following along closely and sharing as well!

Denice

Anononymous

Hi Aviva,
Why is it that most herbalists focus only on Women's health? Possibly that most of them are women, and I fully respect that, but there is so much less information about men's health out there...
From what I see, women are much more comfortable talking about things like lack of sex drive, physical issues, etc, when it comes to their bodies. Look at the covers of all the magazines, the next time you are at the supermarket. All targeted to women, telling them how they can have a better sex life, be healthier, etc.
Men, however, many times suffer in silence. Afraid or embarrassed to talk about issues that most women have no problem talking about. So, after suffering and if they have the guts to go to a doctor, many turn to drugs that cause side effects, or pick up an herb in the men’s section in Vitamin Shoppe that is not necessarily the best thing for them, simply because the information out there is scarce. Yohimbe can kill you…
I don’t mean any disrespect, and keeping the women in my life healthy is very extremely important to me. However, I would hope that keeping the men in the lives of women healthy is important to them as well.

aviva

The herbal movement has historically been "dominated" by women largely because it partially arose from the women's and self-help movements, with women seeking ways to reclaim control over their own health. There are more women herbalists and many women feel more comfortable taking care of other women, particularly since a great deal of herbal practice occurs in the homes of herbalists. Also, few women herbalists have clinical experience with men's reproductive health conditions. It is actually only my training in medical school that really gave me full access to caring for large numbers of men to the extent that I now feel very comfortable taking care of men's health issues. Interestingly, my male patients are always more comfortable bringing up sexual and repro health issues to me. Women don't like to admit to sexual dysfunction and related problems. Men are more apt to: ED is not something men willingly live with. Lack of satisfaction is something women are practically programmed to endure. There are a few fantastic herbalists who focus on men's health - Eric Yarnell and James Green (who has a book on the subject) are two that come to mind. And I've sponsored several talks on the topic at the American Herbalists Guild conference when I ran the organization. You can access some of those on the AHG website as a member (I am no longer affiliated). My website is really about women's and children's health - those are my passions and areas of specialty. And one can only take on so much and provide meaningful, thoughtful, well-studied info. So no intention to marginalize anyone. I do take care of men in my private practice. I think most of us ladies reading here would agree that men's health is incredibly important and we want you to feel healthy and cared for, too! Thanks for writing!

Kelsey

I'm looking forward to reading your upcoming blogs on this topic! Thank you for sharing your wisdom with us :) I already have plans for this Saturday night so I will be missing the Tellejam. Will there be any sort of recap on the info shared during the Jam?

Anonymous

Writing down questions or issues, or a copy of an article on the topic about which you have a concern, and handing them to a healthcare practitioner is one way to raise topics that you find difficult to discuss.

Mujer

Thank you for covering this topic.
I agree with the comment before, it is always asummed that women are the ones that don't like sex, don't know enough or may not have enough drive.
My question is how to mantain a healthy relationship with a husband who has less sex drive. He loves to hold hands, cuddle and have sex on average 4 times a year. I have learn to accept this, but deep inside I feel as if I was on a forced chocolate diet. The roller coaster experience of an affair is not worth it, but there is always a drop of ... Not sadness, more like coldness that no dancing can fulfill.

mamayorgensen

excited for this series! I am interested in the way our bodies make hormones that give us (or at least me) sex drive first half of my cycle and none the second half! Getting worse as I get older...still working on the balance of honoring where my physical body is and honoring where my mental body wants my physical to be!

Lacey

aviva

sophie

I was wondering what can be done for urinary incontinence (after sneezing, jumping rope, running, doing any kind of physical jolting movement) in women after giving birth. Nothing was mentioned at follow up doctor appointments. I thought it was common or at least just a side effect of women after givng birth. It wasn't until I read a book about french women that I found out it wasn't normal and accepted around the world. Why don't our US doctors address this issue. I even had female ob/gyn doctors and still no one mentioned this.

Amy

anonymous

aviva

Yes,something like 50% of women over 45 have some incontinence of urine. It's not fun. Things to do: pelvic floor exercises intensely and religiously, consult with a urogynecologist to find out exactly the nature of the incontinence, pee when you feel the urge rather than waiting as so many women do. Yes, I am reading about French postpartum perineal care. The thing is that it is always framed as more pleasurable for the husband -- but I am intrigued by the aggressive postpartum perineal rehabilitation. I've had this in mind for a post you have inspired me to write more about incontinence and this French method. What was the book you read? Thank you!

Sabrina

aviva

mildred

oh genie i have 4 questions....
The first 3 are related to this story (you may skip the story if there isn't time)....
I went through 2 american boyfriends that didnt give me the real big orgasms. Our sexual relationships were not worthy of acquiring birth control. I didnt want to be hormonally adjusted or controlled, It just seems weird and wrong, for myself...I used multiple fertility awareness techniques successfully for ~11 years. Luckily, during this time, some other encounters taught me that i ejaculate and there was more to life than disinterested (and circumcised) boys..... Now i have a much more satisfying partner and finally got a "Paragard" non-hormonal IUD....in 2010. It wasnt easy to get! I had previously had a pap that showed one of the "bad" strains of HPV. I was told that a Paragard would "give" me cervical cancer and that I would bleed and hurt all the time, wouldn't want sex, wouldn't be attractive to "my boyfriend" And when i wanted to have it taken out, she wouldn't do it for me because she "told me so" ..... I found a new clinic immediately and eventually got one. The string was cut a bit short by mistake, hopefully a blessing because A. perhaps it won't rub on my cervix as much as it would and B. it wont be a bacterial-viral highway from vagina to uterus and C. I am not the kind of person who is going to ignore/not feel the pain of an paragard being expelled....though it could embed in my uterus without my noticing....if i allow myself to go for years without being risking being poked, prodded and investigated (that is what is happening). I guess I was advised to have ultrasounds to check on the IUD's location from time to time.....I doubt that is gonna happen as I am rather poor, transient, happy and healthy- these days. Getting myself into the latest clinic to get all signed up as a homeless so they can fill me with fear.... before I'm off to another town ... is not on my list of important things to do!
I Did have a clear pap tests (no HPV) since the insertion. I have also been strictly monogamous.
So....I would be pleased to learn more, if these are appropriate topics , i guess that the 3rd is the most important....
1. I am curious about female ejaculation...usually mine doesnt smell, sometimes it might be pee, and one time it soaked 1/2 a mattress and smelled rather sharp, not like pee though.... sometimes there is so much of it, it can be almost inhibiting I have never bothered to do research, though i know it is a known phenomenon. I don't really want to read through what i might find about it online.
2. bleeding after sex....i do enjoy rough sometimes, but am i okay if i am spotting for 1-4 days after? should i be gentler with my vagina? or can i do what i like? It's never heavy bleeding but sometimes it seems to go on for awhile.
3. What is the current consensus on the Paragard IUD about low-level infection? I like my immune system to be as strong as possible (seriously, i don't eat sugar!) ....There is the real possibility that I am subsisting rather symptom-free right now with any of the following low level stresses- lyme's spirocetes (one equivocal test and tons of exposure, not really any red-flag symptoms), protozoan parasites (no positives with limited testing but i have had symptoms of acute and chronic), and sporotrichosis (rose's gardeners disease or infective arthritis in one knuckle that got a deep thorn prick 6 months ago but is consistently mildly swollen).
another note on the (not so important) IUD storytime.....
my mother had a lippe's loop that got pulled out with a tampon!
The Story Goes that the low-level infection, due to the IUD, is what blocked her fallopian tubes with scar tissue. She had to have her fallopian tubes cleared surgically to become pregnant both times after the IUD. (?the story goes....)
I am still devoted to Not birthing any children, ever (i am 31). So I doubt that otherwise heathly damage/scarring in my reproductive organs would be an issue.
But I am concerned about the possibility that the IUD functions due to low-level infection (makes you sick enough, all the time, that your body won't start a baby). Rather than the Paragard functioning due to some mysterious action of the copper wire.
Oy....I dont quite like this lack of real information inside my womb. But i think positively on it as a beneficial and magical pessary. :)
Question #4
Chin Pimples or "deep within my chin is one giant pimple factory". Now, I have learned to manage and embrace the few days of extra anxieties...(just add stress and it can blossom into extra delusions!) that fall between my ovulation and bleeding time. I'm good for that....But what I wish i could do something for is how i get these enormous pimples that are scarring up my chin. My mother also had clear skin until about 25 and continued with cyclical pimples until menopause.
wish i could fix them, they look gross, often hurt and are almost endless. I do wash my face.
Thank you so much for summoning our questions. Im looking forward to what information you may choose to desseminate.
You have my permission to post or otherwise use this information in public.

aviva

hi mildred,
first, kudos for your courage and your generosity in offering this to be posted. this is how we all learn what each other is experiencing -- and you are not unusual in your concerns and questions. very brave! thank you.
1. Female ejaculation: my dear friend Sheri Winston, a midwife and sex educator, has a fabulous book called Women's Anatomy of Arousal. It won the sex therapist's best book of the year award! She discusses the phenomenon of female ejaculation. it would be a great resource for you; you can also search by name and you will find her website.
2. Bleeding after sex sometimes happens, and may be due to some irritation from your iud, or what is called a friable cervix -- the tissue is delicate and tears more easily. however, it is also important to make sure you have an up to date pap smear to make sure nothing worrisome is causing the bleeding.
3. IUDs and low level infection: it is possible that IUDs might cause some low level chronic inflammation; they should not be causing infection. IUDs from the 60s and 70s were much more likely to cause infection and scarring. They are much better and safer now. It's a good method of contraception.
4. Chin pimples are super common before the period, and even at other times of the month, and are, no surprise, largely hormonal. So getting hormones in balance is key. This is a big topic (blog in process!). Things to consider: eliminating sugar, decreasing stress, making sure thyroid function is normal (look up symptoms and see if you have them or get some blood work to check), make sure you are having a bowel movement daily, take 2 tbs fresh ground flax daily, exercise, get enough sleep, and eat super well! Simpler than it sounds!
Be well!
Aviva

Maria

Thanks so much for this! I so appreciate it.
My question is about the misconception that I have to be fit and skinny in order to feel or be sexy. Especially after having 3 babies my body has changed so much, it's hard for me to think of myself as sexy and deserving good sex when I don't look the way I used to. It doesn't help to have a husband who agrees with that....whenever I bring it up and say that my body has changed so much after the pregnancies, he says that it's just an excuse not to take responsibility for getting in shape again. I know I need to lose 10-15lbs, but I want to be able to feel sexy and deserving of a good sex life no matter how I look. And I know I'm not alone in this.

Sophie

Looking forward to the upcoming seminar with Susun!
I have a question that I would love for you to address there.
I am 35 and had 2 kids. I feel like after having kids my vagina is too loose, has less "gripping" power (for the lack of a better word) and I also now tend to get air in my vagina during the sex, which when it comes out sounds embarrassing.
What can I do about it?
Thanks

tracy

Jill

Hi Aviva! So excited for this series...I am wondering if you can speak to healing negative ideas regarding sexuality received when a child and during the formative teenage years? Sex in my family of origin was shameful and sinful, add in our culture's strange relationship with female sexuality...My internal self is conflicted, though my logical brain tells me sex and sexuality and feminine sexual strength are healthy and normal...I still struggle with feeling of shame, etc.??

aviva

Hi Jill,
Thank you for your candid email and my apologies for such a long delay in my reply. There are some great women out there who provide counseling around these issues, and I know an Amazon search will yield a number of excellent books. BEing open and aware, as you so clearly are is the first step. Educating yourself and doing some healing work around the inner conflict from the negative childhood influences might really help - working with someone who can help you reframe. Also reading about women's history, for example, Women as Healers by Jeanne Achterberg, When God WAs a Woman by Merlin Stone, and Shakti Woman by Elizabeth Noble might give you some woman power energy behind all of it to help you see your family's ideas in a social or perhaps religious context, and find new ways to embrace your feminine power! I'm rooting for ya! :) Aviva

Danielle Sales

Kim

I have a few questions. I am 55 and went through menopause 6 or so years ago. I had some problems with hot flashes but used an over the counter herbal combination that worked great. I no longer take it because I don't have that problem any more. Anyway, My husband has had a lot of major health problems and our sexual relationship has been minimal to non existent for a number of years. We are trying to rekindle that when he feels good. I am struggling because it is very painful. It is like there is no elasticity to the vaginal opening. Is that normal. Is there something you can do about it?

aviva

Hi Kim. It sounds like you've been through a lot! My heart goes out to you and I am so glad you and your guy are both into trying to keep your intimacy alive! As we get older and our estrogen declines, our vaginal tissue does tend to become less elastic and less moist - and this can make intercourse painful. A few things: one, lots for foreplay can help get you lubricated and make penetration more comfortable, using lots of lubricant can help, and using herbs and foods to support estrogen can be helpful (I'll be blogging about sex after menopause in the next couple of weeks and will include details about foods, herbs, and supplement). If things are really like a desert or super non-elastic down there, and you don't have significant cancer risk factors, you could also consider occasional, ie weekly, use of a topical vaginal estrogen cream to keep that tissue healthy and restore tone and moisture. There is some absorption but if you are low risk, this can be a reasonable option. <3 Aviva